Purpose: This study aimed to compare the surgical outcomes of 23-gauge (g) micro-incision vitrectomy surgery (MIVS) and 25-g MIVS for lens fragments that dropped into the vitreous cavity during cataract surgery. Methods: This study was a comparative, retrospective, and interventional case series study based on a medical records review. Sixty-six eyes of 66 patients with dropped lens fragments in the vitreous cavity during MIVS, performed between January 1, 2014 and December 31, 2017, were included. The characteristics of the patients and their visual acuity, operation time duration, and complication rate were analyzed retrospectively. Results: 23-MIVS and 25-g MIVS were performed on 41 and 25 eyes, respectively. The mean value of best-corrected visual acuity (logMAR) improved significantly from 1.79 ± 1.12 to 0.36 ± 0.63 in the 23-g group and from 1.82 ± 1.15 to 0.31 ± 0.53 in the 25-g group (p < 0.001). The mean operation time was 33.0 ± 6.8 minutes in the 23-g group and 32.3 ± 6.9 minutes in the 25-g group, with no significant difference between the two groups (p = 0.694). There were two cases of postoperative cystoid macular edema in the 23-g group; however, no significant difference with regard to postoperative complications was found between the two groups (p = 0.262). Conclusions 23- and 25-g MIVS for lens fragments dropped into the vitreous cavity during cataract surgery is a comparably safe and effective method for reducing the size of the incision and shortening the operation time.

Purpose: To evaluate the clinical outcomes of 25-gauge microincision vitrectomy for vitreoretinal diseases in patients who have undergone glaucoma drainage implant surgery for the treatment of neovascular glaucoma. Methods: We retrospectively examined the preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and complications of patients with previous Ahmed valve implantation surgery who underwent vitrectomy and were available for follow-up for at least 6 months. Results: A total of 20 eyes had Ahmed valve implantation for neovascular glaucoma, of which 16 eyes (80%) had proliferative diabetic retinopathy, and 4 eyes (20%) had central retinal vein occlusion. All eyes underwent 25-gauge microincision vitrectomy for the treatment of vitreous hemorrhage unresponsive to conservative treatment. BCVA (logarithm of minimal angle of resolution, logMAR) improved from 1.08 ± 0.29 preoperatively to 0.61 ± 0.32 (p = 0.004) postoperatively. Mean IOP increased from 16.2 ± 3.4 mmHg preoperatively to 17.4 ± 2.8 mmHg at 6 months postoperatively (p = 0.569), with no significant change. There were no cases of exposed body or tube of Ahmed valve after surgery, and vitreous hemorrhage (7 eyes, 31.8%) was the most common complication. Conclusions With a carefully chosen incision site, 25-gauge microincision vitrectomy is an effective treatment method to treat vision-threatening complications such as vitreous hemorrhage in eyes previously implanted with a glaucoma drainage device, with minimal impact on elevated intraocular pressure.

Germline mutations in the BRCA1 and BRCA2 genes are strong genetic factors for predispositions to breast, ovarian, and other related cancers. This report describes a family with a history of breast and ovarian cancers that harbored a novel BRCA1 germline mutation. A single nucleotide deletion in intron 20, namely c.5332+4delA, was detected in a 43-year-old patient with breast cancer. This mutation led to the skipping of exon 20, which in turn resulted in the production of a truncated BRCA1 protein that was 1773 amino acids in length. The mother of the proband had died due to ovarian cancer and had harbored the same germline mutation. Ectopically expressed mutant BRCA1 protein interacted with the BARD1 protein, but showed a reduced transcriptional function, as demonstrated by the expression of cyclin B1. This novel germline mutation in the BRCA1 gene caused familial breast and ovarian cancers.
Adult ; Amino Acids ; BRCA1 Protein ; Breast Neoplasms* ; Breast* ; Cyclin B1 ; Exons* ; Genes, BRCA1 ; Genes, BRCA2 ; Germ-Line Mutation* ; Humans ; Introns ; Mothers ; Ovarian Neoplasms

BACKGROUND: Tumor necrosis factor-alpha (TNF-α) inhibitors (TNFis), which are the main treatment for ankylosing spondylitis (AS), have been reported not only to reduce the incidence of anterior uveitis (AU) but also to induce it, and these effects differ among the various types of TNFis in clinical use. The present study investigated the effect of TNFis on uveitis by analyzing the long-term clinical course of AU in AS patients treated with TNFi therapy. METHODS: Patients treated with at least one TNFi between January 2007 and July 2017 were reviewed, and 54 patients with at least one episode of AU were included in this study. The TNFis included anti-TNF-α antibodies (adalimumab, infliximab, and golimumab), and a soluble TNF receptor molecule (etanercept). The effect of prevention of AU, the likelihood of new-onset uveitis after the initiation of TNFi therapy, and the effects of drug switching and dose escalation were assessed. RESULTS: The first uveitis flare was observed before TNFi therapy in 39 patients and after TNFi therapy in 15 patients. Anti-TNF-α antibodies were more efficacious in decreasing the recurrence of AU than etanercept. Among patients in which uveitis first occurred after beginning TNFi therapy, patients on etanercept tended to first develop AU less than 1 year after starting the drug, and their AS tended to be well-controlled at the time of uveitis flares. Patients with a uveitis flare before their medication was switched did not recur afterwards, and five of eight patients showed no relapse after dose escalation. CONCLUSION: TNFis have various effects on AU. TNFis, particularly anti-TNF-α antibodies, should be considered in patients with AS and frequent AU relapse. Additionally, clinicians should consider whether AU is due to an absence of a therapeutic response of AS to TNFi treatment or to TNFi treatment itself, and appropriate treatment changes should be made accordingly.
Adalimumab ; Antibodies ; Drug Substitution ; Etanercept ; Humans ; Incidence ; Infliximab ; Receptors, Tumor Necrosis Factor ; Recurrence ; Spondylitis, Ankylosing ; Tumor Necrosis Factor-alpha ; Uveitis ; Uveitis, Anterior

Purpose: Natural medicinal plant extracts have recently attracted attention as health beneficial foods and potential therapeutic agents for prevention of various diseases. This study was undertaken to measure the anti-inflammatory effect of the ethanol-water fraction obtained from the above-ground portion of Spiraea prunifolia var. simpliciflora, a wild-growing plant in Korea. The final fraction used in this study was the H 2 O-EtOH (40:60) fraction (SP60), which had the highest antioxidant activity, as determined in previous studies. Methods: The amounts of nitric oxide (NO), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-1β production were measured in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells exposed to SP60. Western blot was performed to measure the expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-2, and the activation of nuclear factor (NF)-κB. Results: SP60 exerted no cytotoxicity up to concentrations of 125 μg/mL. The levels of inflammatory cytokines, such as NO, TNF-α, IL-6, and IL-1β, were significantly decreased in LPS-stimulated RAW264.7 cells exposed to SP60. In addition, the expression levels of iNOS, COX-2, and phosphorylated p65 showed a concentration-dependent decrease subsequent to SP60 treatment. These results indicate that SP60 inhibits the LPS-induced production of inflammatory cytokines, iNOS, and COX-2, by inhibiting the activation of NF-κB, which is responsible for the expression of inflammatory mediators. Conclusion The results presented in this study indicate that the H 2 O-EtOH (40:60) fraction (SP60) extracted from the above-ground portion of Spiraea prunifolia var. simpliciflora has

Background: Medical malpractice during endotracheal intubation can result in catastrophic complications. However, there are no reports on these severe complications in South Korea. We aimed to investigate the severe complications associated with endotracheal intubation occurring in South Korea, via medicolegal analysis. Methods: We retrospectively analyzed the closed judicial precedents regarding complications related to endotracheal intubation lodged between January 1994 and June 2020, using the database of the Supreme Court of Korea. We collected clinical and judicial characteristics from the judgments and analyzed the medical malpractices related to endotracheal intubation. Results: Of 220 potential cases, 63 were included in the final analysis. The most common event location was the operating room (n = 20, 31.7%). All but 3 cases were associated with significant permanent or more severe injury, including 31 deaths. The most common problems were failed or delayed intubation (n = 56, 88.9%). Supraglottic airway device was used in 5.2% (n = 3) cases of delayed or failed intubation. Fifty-one (81%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of Korean Won 133,897,845 (38,000,000, 308,538,274). The most common malpractice recognized by the court was that of not attempting an alternative airway technique (n = 32, 50.8%), followed by violation of the duty of explanation (n = 10, 15.9%). Conclusion Our results could increase physicians’ awareness of the major complications related to endotracheal intubation and help ensure patient safety.

BACKGROUND: Complex regional pain syndrome (CRPS) involves severe pain and it is difficult to identify the exact cause or pathogenesis. Therefore, there are controversies regarding legal issues related to the establishment of damage in medical malpractice lawsuits involving CRPS. This study aimed to analyze malpractice lawsuits involving CRPS, which occurred after the disputed medical treatment, to provide information on the courts' opinion and characteristics of the cases. METHODS: This study analyzed 23 lawsuit judgments involving CRPS that were sentenced from 2005 to 2015. RESULTS: A total of 12 of the 23 cases were partially ruled in favor of the plaintiff. The average amount (KRW) claimed was 470,638,385 ± 860,634,092 (21,000,000 to 4,020,000,000), and that awarded was 72,906,843 ± 53,389,367 (15,000,000 to 181,080,803). Sixteen of the 23 cases had CRPS type I. In 11 of 23 cases, the site of the pain was located in the lower limb and in 14 cases there was no presence of trauma or event prior to medical treatment. CONCLUSION: Nerve injury was the most frequent reason for taking responsibility in compensating damage in malpractice cases involving CRPS. Physicians should consider various possibilities of such complications in medical practices. It is important to identify and improve areas which need to be improved for patient safety through analyzing the lawsuit judgment cases.
Awards and Prizes ; Complex Regional Pain Syndromes ; Judgment ; Jurisprudence ; Lower Extremity ; Malpractice ; Patient Safety

PURPOSE: The purpose of this study was to compare the success rate of re-excision and breast-conserving surgery (BCS) between patients who received neoadjuvant chemotherapy and those who did not. METHODS: In this retrospective cohort study, 256 women who had clinical T2 breast cancer and planned to receive, as initial treatment either BCS (n=197) or neoadjuvant chemotherapy (n=59) between January 2009 and December 2012 were included. The data, including age, initial tumor size, mammographic microcalcification, ultrasound multifocality and axillary nodal status, were collected. The pathologic tumor size, p-multifocality, histologic type, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, ductal carcinoma in situ (DCIS) and extensive intraductal component (EIC) were also reviewed. The re-excision and BCS success rates were investigated. Univariate analysis and regression model were used. To reduce the effect of selection bias, propensity score matching-based analysis was also performed. RESULTS: Of the 256 patients, 178 patients (90.4%, 178/197) in the non-neoadjuvant group and 56 patients (94.9%, 56/59) in the neoadjuvant group received BCS (p=0.406). In propensity-matched cohorts (n=118), the re-excision rate was similar in the two groups (35.6% in neoadjuvant group vs. 35.6% in non-neoadjuvant group, p=1.000). BCS success rate was slightly higher in neoadjuvant group (94.9%, 56/59) than in non-neoadjuvant group (86.4% [51/59], p=0.205). In logistic regression model, clinicopathologic factors associated with re-excision were pathologic multifocality (odds ratio [OR], 4.56; p=0.0142), high Ki-67 (≥50%) (OR, 0.7; p=0.0243) and DCIS component (OR, 2.67; p=0.0261). CONCLUSION: This study showed that neoadjuvant chemotherapy could increase the success rate of BCS but could not decrease that of re-excision. The re-excision rate is more associated with pathologic finding rather than the effect of neoadjuvant chemotherapy.
Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Cohort Studies ; Drug Therapy* ; Estrogens ; Female ; Humans ; Logistic Models ; Mastectomy, Segmental ; Propensity Score ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies ; Selection Bias ; Ultrasonography

Background: Due to its abuse potential, propofol has been classified as a controlled substance since February 2011 in South Korea. Healthcare workers are exposed to propofol abuse considering their easy access to this substance in hospitals. Therefore, we aimed to investigate propofol abuse among healthcare workers through the database of the Supreme Court in South Korea. Methods: We retrospectively analyzed adjudicated criminal cases related to propofol abuse among healthcare workers from January 1, 2013, to December 31, 2020, using the database of the Supreme Court of South Korea’s judgments. We collected the clinical characteristics and punishment-related information of healthcare workers who abused propofol. Results: Of the 194 cases collected using the search term ‘propofol,’ 20 were included in the final analysis. The most common healthcare workers who abused propofol were nursing aides (n = 15). Among them, 40% (n = 8) of the defendants had previously been punished for substance abuse, and 35% (n = 7) had a history of psychological disease. Of the defendants, 65% (n = 13) self-administered propofol more than twice, and the median number of self-administrations was three. Except for two, the defendants were sentenced to imprisonment, including suspended sentences, and the median values of their duration of prison and probation were 9 months and 24 months. Conclusions Despite propofol being strongly regulated as a controlled substance in South Korea, its abuse among healthcare workers remains. Healthcare workers should be vigilant against its abuse among themselevs.

CTHRC1 (collagen triple-helix repeat-containing 1), a protein secreted during the tissue-repair process, is highly expressed in several malignant tumors, including pancreatic cancer. We recently showed that CTHRC1 has an important role in the progression and metastasis of pancreatic cancer. Although CTHRC1 secretion affects tumor cells, how it promotes tumorigenesis in the context of the microenvironment is largely unknown. Here we identified a novel role of CTHRC1 as a potent endothelial activator that promotes angiogenesis by recruiting bone marrow-derived cells to the tumor microenvironment during tumorigenesis. Recombinant CTHRC1 (rCTHRC1) enhanced endothelial cell (EC) proliferation, migration and capillary-like tube formation, which was consistent with the observed increases in neovascularization in vivo. Moreover, rCTHRC1 upregulated angiopoietin-2 (Ang-2), a Tie2 receptor ligand, through ERK-dependent activation of AP-1 in ECs, resulting in recruitment of Tie2-expressing monocytes (TEMs) to CTHRC1-overexpressing tumor tissues. Treatment with a CTHRC1-neutralizing antibody-abrogated Ang-2 expression in the ECs in vitro. Moreover, administration of a CTHRC1-neutralizing antibody to a xenograft mouse model reduced the tumor burden and infiltration of TEMs in the tumor tissues, indicating that blocking the CTHRC1/Ang-2/TEM axis during angiogenesis inhibits tumorigenesis. Collectively, our findings support the hypothesis that CTHRC1 induction of the Ang-2/Tie2 axis mediates the recruitment of TEMs, which are important for tumorigenesis and can be targeted to achieve effective antitumor responses in pancreatic cancers.
Angiopoietin-2 ; Animals ; Carcinogenesis ; Endothelial Cells ; Heterografts ; In Vitro Techniques ; Mice ; Monocytes* ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Receptor, TIE-2 ; Transcription Factor AP-1 ; Tumor Burden ; Tumor Microenvironment